Publications by authors named "Emily Hughes"

32 Publications

Teleglaucoma Initiative at a Veterans Affairs Hospital: Pilot Safety Data and Early Experience.

Ophthalmol Glaucoma 2021 Nov-Dec;4(6):632-637. Epub 2021 Apr 9.

Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Purpose: To evaluate the safety, reliability, and efficacy of telemedicine in delivering tertiary subspecialty glaucoma care (herein referred to as teleglaucoma) to the veteran patient population.

Design: Prospective case series.

Participants: Twenty patients being referred for glaucoma subspecialist opinion participated in the pilot safety study. One hundred eighteen patients participated in the secondary study of the acceptability and service efficacy of teleglaucoma.

Methods: In the pilot study, safety was assessed by determining interobserver and intraobserver consistency (Krippendorff's α). This compared an in-person assessment by a glaucoma subspecialist with the remote assessment of 2 other glaucoma subspecialists (electronic health record alone reviewed). In the secondary study, teleglaucoma was implemented whereby testing and eye examination were carried out remotely by an optometrist or comprehensive ophthalmologist, and the clinical decision was made by the glaucoma subspecialist on review of the electronic health record alone.

Main Outcome Measures: In the pilot study, interobserver and intraobserver consistency in making a diagnosis and treatment plan (acceptable, ≥ 0.80 Krippendorff's α). In the secondary study, patient satisfaction measured by survey, wait time for teleglaucoma opinion versus wait time for in-person opinion, and time spent on teleglaucoma consultations.

Results: Interobserver and intraobserver consistency showed an α of 0.86 and 0.92, respectively, for diagnosis, and 0.86 and 0.85, respectively, for treatment plan. In the secondary study, patient satisfaction was 4.55 of 5.00 (5 = maximum satisfaction; range, 3.28-4.93). Improved consultation lead time was demonstrated, with the median time for a doctor to respond to an electronic consultation being 3 days, versus 43 days for an in-person visit. Teleglaucoma also demonstrated positive benefits to the health care system by reducing the time doctors spent reviewing each patient's case (history, examination findings, imaging results, visual fields; 19 minutes for teleglaucoma consultation vs. 31 minutes for in-person evaluation).

Conclusions: Decisions regarding diagnoses and treatment plans between in-person consultation and the teleglaucoma program showed high reliability. Patient satisfaction was high. Additional benefits were observed in wait time for subspecialty glaucoma opinion, efficient allocation of the doctor's time, and fiscal benefit to the health care system.
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http://dx.doi.org/10.1016/j.ogla.2021.03.016DOI Listing
April 2021

Understanding fish cognition: a review and appraisal of current practices.

Anim Cogn 2021 May 17;24(3):395-406. Epub 2021 Feb 17.

Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada.

With over 30,000 recognized species, fishes exhibit an extraordinary variety of morphological, behavioural, and life-history traits. The field of fish cognition has grown markedly with numerous studies on fish spatial navigation, numeracy, learning, decision-making, and even theory of mind. However, most cognitive research on fishes takes place in a highly controlled laboratory environment and it can therefore be difficult to determine whether findings generalize to the ecology of wild fishes. Here, we summarize four prominent research areas in fish cognition, highlighting some of the recent advances and key findings. Next, we survey the literature, targeting these four areas, and quantify the nearly ubiquitous use of captive-bred individuals and a heavy reliance on lab-based research. We then discuss common practices that occur prior to experimentation and within experiments that could hinder our ability to make more general conclusions about fish cognition, and suggest possible solutions. By complementing ecologically relevant laboratory-based studies with in situ cognitive tests, we will gain further inroads toward unraveling how fishes learn and make decisions about food, mates, and territories.
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http://dx.doi.org/10.1007/s10071-021-01488-2DOI Listing
May 2021

Implementing patient direct access to musculoskeletal physiotherapy in primary care: views of patients, general practitioners, physiotherapists and clinical commissioners in England.

Physiotherapy 2021 Jun 11;111:31-39. Epub 2020 Jul 11.

Primary Care Centre Versus Arthritis, Faulty of Medicine and Health Sciences, Keele University, Staffordshire, United Kingdom. Electronic address:

Purpose: Musculoskeletal problems are the leading cause of chronic disability. Most patients in the UK seek initial care from general practitioners (GPs), who are struggling to meet demand. Patient direct access to National Health Service physiotherapy is one possible solution. The purpose of this study was to understand the experiences of patients, GPs, physiotherapists and clinical commissioners on direct access in a region in England with it commissioned.

Methods: The study was informed by Normalisation Process Theory (NTP). Data collection was via semi-structured individual face-to-face and telephone interviews with 22 patients and 20 health care professionals (HCPs). Data were analysed thematically using NPT.

Results: Three themes emerged: understanding physiotherapy and the direct access pathway; negotiating the pathway; making the pathway viable. HCPs saw direct access as acceptable. Whilst patients found the concept of direct access, those with complex conditions continued to see their GP as first point of contact. Some GPs and patients reported a lack of clarity around the pathway, reflected in ambiguous paperwork and inconsistent promotion. Operational challenges emerged in cross-disciplinary communication and between HCPs and patients, and lack of adequate resources.

Conclusion: Direct access to NHS musculoskeletal physiotherapy is acceptable to patients and HCPs. There is need to ensure: effective communication between HCPs and with patients, clarity on the scope of physiotherapy and the direct access pathway, and sufficient resources to meet demand. Patient direct access can free GPs to focus on those patients with more complex health conditions who are most in need of their care.
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http://dx.doi.org/10.1016/j.physio.2020.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120843PMC
June 2021

Exploring Pasifika wellbeing: findings from a large cluster randomised controlled trial of a mobile health intervention programme.

N Z Med J 2020 10 30;133(1524):82-101. Epub 2020 Oct 30.

Professor/Co-Principal Investigator, National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland.

Aim: The primary objective of this study was to determine the effect of a mobile health (mHealth) intervention on the wellbeing of Pasifika peoples, and to explore factors associated with Pasifika wellbeing.

Methods: The [email protected]@ mHealth programme was a co-designed smartphone app. Culturally relevant data was collected to examine holistic health and wellbeing status, at baseline, and at 12 weeks (end of the trial). The concept of wellbeing was examined as part of a two-arm, cluster randomised trial, using only the Pasifika data: 389 (of 726) Pasifika adults were randomised to receive the mHealth intervention, while 405 (of 725) Pasifika adults were randomised to receive a control version of the intervention. Culturally relevant data was collected to examine holistic health and wellbeing status, at baseline, and at 12 weeks (end of the trial). The intervention effects and the association of demographic and behavioural relationships with wellbeing, was examined using logistic regression analyses.

Results: Relative to baseline, there were significant differences between the intervention and control groups for the 'family/community' wellbeing, at the end of the 12-week trial. There were no significant differences observed for all other wellbeing domains for both groups. Based on our multivariate regression analyses, education and acculturation (assimilation and marginalisation) were identified as positively strong factors associated to Pasifika 'family and community' wellbeing.

Conclusion: Our study provides new insights on how Pasifika peoples' characteristics and behaviours align to wellbeing. Our findings point to 'family and community' as being the most important wellbeing factor for Pasifika peoples.
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October 2020

Examining the roles of metacognitive beliefs and maladaptive aspects of perfectionism in depression and anxiety.

Behav Cogn Psychother 2020 Jul 16;48(4):442-453. Epub 2020 Mar 16.

Discipline of Psychology, School of Social Sciences, University of the Sunshine Coast, Queensland, Australia.

Background: Metacognition and perfectionism are factors found to be associated with both anxiety and depression. A common component that underlies these factors is the influence of perseverance, or the tendency to continue a behaviour or thought even if it is no longer productive.

Aims: This study aimed to investigate the relationships between metacognitive beliefs with maladaptive aspects of perfectionism (i.e. perseverance behaviours), and their relation to anxiety and depression.

Method: Participants (n = 1033) completed six self-report questionnaires measuring metacognitive beliefs about rumination and worry, perseverance, anxiety and depression. Data were analysed using correlational testing, and structural equation modelling.

Results: Results of structural equation modelling revealed that positive metacognitive beliefs about repetitive negative thinking increased the likelihood to perceive the thinking as uncontrollable, and that perseverance behaviours were predicted by all metacognitive beliefs. Furthermore, examination of partial correlations revealed that both negative metacognitive beliefs about repetitive negative thinking and perseverance behaviours predicted anxiety and depression; however, negative metacognitive beliefs were the strongest predictor, in both cases.

Conclusions: The results provided support for current metacognitive models, in that the interpretation of cognitive perseveration sequentially influences psychopathology, but also provided insight into the inclusion of perseveration behaviours. Furthermore, the findings may also have value in a clinical setting, as targeting metacognitive beliefs in the presence of perseverance type behaviours may prove beneficial for treatment.
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http://dx.doi.org/10.1017/S1352465820000144DOI Listing
July 2020

Student engagement and wellbeing over time at a higher education institution.

PLoS One 2019 27;14(11):e0225770. Epub 2019 Nov 27.

Computer Science, University of Exeter, Exeter, United Kingdom.

Student engagement is an important factor for learning outcomes in higher education. Engagement with learning at campus-based higher education institutions is difficult to quantify due to the variety of forms that engagement might take (e.g. lecture attendance, self-study, usage of online/digital systems). Meanwhile, there are increasing concerns about student wellbeing within higher education, but the relationship between engagement and wellbeing is not well understood. Here we analyse results from a longitudinal survey of undergraduate students at a campus-based university in the UK, aiming to understand how engagement and wellbeing vary dynamically during an academic term. The survey included multiple dimensions of student engagement and wellbeing, with a deliberate focus on self-report measures to capture students' subjective experience. The results show a wide range of engagement with different systems and study activities, giving a broad view of student learning behaviour over time. Engagement and wellbeing vary during the term, with clear behavioural changes caused by assessments. Results indicate a positive interaction between engagement and happiness, with an unexpected negative relationship between engagement and academic outcomes. This study provides important insights into subjective aspects of the student experience and provides a contrast to the increasing focus on analysing educational processes using digital records.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225770PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6881016PMC
March 2020

Longitudinal clusters of pain and stiffness in polymyalgia rheumatica: 2-year results from the PMR Cohort Study.

Rheumatology (Oxford) 2020 08;59(8):1906-1915

Primary Care Centre Versus Arthritis, School for Primary, Community and Social Care, Keele University, Keele, UK.

Objectives: To investigate potential subgroups of primary care-diagnosed patients with PMR based on self-reported pain and stiffness severity over time.

Methods: A total of 652 people with an incident PMR diagnosis were recruited from English general practices and completed a baseline postal questionnaire. They were followed up with a further six questionnaires over a 2 year period. A total of 446 people completed the 2 year follow-up. Pain and stiffness were reported on a 0-10 numerical rating scale. Latent class growth analysis was used to estimate the joint trajectories of pain and stiffness over time. A combination of statistical and clinical considerations was used to choose the number of clusters. Characteristics of the classes were described.

Results: Five clusters were identified. One cluster represented the profile of 'classical' PMR symptoms and one represented sustained symptoms that may not be PMR. The other three clusters displayed a partial recovery, a recovery followed by worsening and a slow, but sustained recovery. Those displaying classical PMR symptoms were in better overall health at diagnosis than the other groups.

Conclusion: PMR is a heterogeneous condition, with a number of phenotypes. The spectrum of presentation, as well as varying responses to treatment, may be related to underlying health status at diagnosis. Future research should seek to stratify patients at diagnosis to identify those likely to have a poor recovery and in need of an alternative treatment pathway. Clinicians should be aware of the different experiences of patients and monitor symptoms closely, even where there is initial improvement.
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http://dx.doi.org/10.1093/rheumatology/kez533DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382596PMC
August 2020

A co-designed mHealth programme to support healthy lifestyles in Māori and Pasifika peoples in New Zealand ([email protected]@): a cluster-randomised controlled trial.

Lancet Digit Health 2019 10 17;1(6):e298-e307. Epub 2019 Sep 17.

Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand.

Background: The [email protected]@ mobile health programme was co-designed with Māori and Pasifika communities in New Zealand, to support healthy lifestyle behaviours. We aimed to determine whether use of the programme improved adherence to health-related guidelines among Māori and Pasifika communities in New Zealand compared with a control group on a waiting list for the programme.

Methods: The [email protected]@ trial was a 12-week, two-arm, cluster-randomised controlled trial. A cluster was defined as any distinct location or setting in New Zealand where people with shared interests or contexts congregated, such as churches, sports clubs, and community groups. Members of a cluster were eligible to participate if they were aged 18 years or older, had regular access to a mobile device or computer, and had regular internet access. Clusters of Māori and of Pasifika (separately) were randomly assigned (1:1) to either the intervention or control condition. The intervention group received the [email protected]@ mHealth programme (smartphone app and website). The control group received a control version of the app that only collected baseline and outcome data. The primary outcome was self-reported adherence to health-related guidelines, which were measured with a composite health behaviour score (of physical activity, smoking, alcohol intake, and fruit and vegetable intake) at 12 weeks. The secondary outcomes were self-reported adherence to health-related behaviour guidelines at 4 weeks; self-reported bodyweight at 12 weeks; and holistic health and wellbeing status at 12 weeks, in all enrolled individuals in eligible clusters; and user engagement with the app, in individuals allocated to the intervention. Adverse events were not collected. This study is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12617001484336.

Findings: Between Jan 24 and Aug 14, 2018, we enrolled 337 Māori participants from 19 clusters and 389 Pasifika participants from 18 clusters (n=726 participants) in the intervention group and 320 Māori participants from 15 clusters and 405 Pasifika participants from 17 clusters (n=725 participants) in the control group. Of these participants, 227 (67%) Māori participants and 347 (89%) Pasifika participants (n=574 participants) in the intervention group and 281 (88%) Māori participants and 369 (91%) Pasifika participants (n=650 participants) in the control group completed the 12-week follow-up and were included in the final analysis. Relative to baseline, adherence to health-related behaviour guidelines increased at 12 weeks in both groups (315 [43%] of 726 participants at baseline to 329 [57%] of 574 participants in the intervention group; 331 [46%] of 725 participants to 369 [57%] of 650 participants in the control group); however, there was no significant difference between intervention and control groups in adherence at 12 weeks (odds ratio [OR] 1·13; 95% CI 0·84-1·52; p=0·42). Furthermore, the proportion of participants adhering to guidelines on physical activity (351 [61%] of 574 intervention group participants vs 407 [63%] of 650 control group participants; OR 1·03, 95% CI 0·73-1·45; p=0·88), smoking (434 [76%] participants vs 501 [77%] participants; 1·12, 0·67-1·87; p=0·66), alcohol consumption (518 [90%] participants vs 596 [92%] participants; 0·73, 0·37-1·44; p=0·36), and fruit and vegetable intake (194 [34%] participants vs 196 [30%] participants; 1·08, 0·79-1·49; p=0·64) did not differ between groups. We found no significant differences between the intervention and control groups in any secondary outcome. 147 (26%) intervention group participants engaged with the [email protected]@ programme (ie, set at least one behaviour change goal online).

Interpretation: The [email protected]@ mobile health programme did not improve adherence to health-related behaviour guidelines amongst Māori and Pasifika individuals.

Funding: Healthier Lives He Oranga Hauora National Science Challenge.
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http://dx.doi.org/10.1016/S2589-7500(19)30130-XDOI Listing
October 2019

A 24-month review of globe rupture in a tertiary referral hospital.

Ir J Med Sci 2020 May 13;189(2):723-726. Epub 2019 Sep 13.

Department of Ophthalmology, University Hospital Galway, Newcastle, Galway City, Co. Galway, Ireland.

Background: Globe rupture is a full thickness penetration of the ocular wall. It is a sight-threatening injury and requires emergent ophthalmic management. Prognosis for vision is dependent on the nature of the rupture, as well as clinical and intraoperative exam findings.

Aims: To identify the outcomes of globe rupture in the University Hospital Galway, a tertiary ophthalmic surgery referral unit, over a 24-month period.

Methods: A retrospective review in all cases of globe rupture was undertaken. The nature of the injury, vision, and exam findings at presentation, and intraoperative findings were recorded. Outcomes included vision at most recent follow-up, the development of complications, and the need for further surgery.

Results: A total of 12 cases were identified: 9 blunt injuries (assault, mechanical fall, workplace accident, self-inflicted) and 3 due to penetration with a sharp object (glass fragment, hammering). Globe rupture was almost twice as common in males under 40 years of age, compared with all patients over 40. All eyes with perception of light vision or less at presentation developed phthisis. Further surgery was required in a minority of cases.

Conclusions: Globe rupture after a mechanical fall was most common in the over-75 age group. Globe rupture from assault, followed by workplace injury, was the most common injury in young males under 40. In an Irish setting, this represents a change in the aetiology of globe ruptures in young males compared with rates reported 20 years ago when workplace injuries were more common. The preventable nature of these injuries is highlighted.
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http://dx.doi.org/10.1007/s11845-019-02097-2DOI Listing
May 2020

Mismatch between proposed ability concepts of Graduate Record Examination and critical thinking skills of physical therapy applicants suggested by expert panel in the United States.

J Educ Eval Health Prof 2019 27;16:24. Epub 2019 Aug 27.

Department of Physical Therapy, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN, USA.

Purpose: The Graduate Record Exam (GRE) is a general examination predictive of success in US based graduate programs. Used to assess written, mathematical and critical thinking (CT) skills of students, the GRE is utilized for admission to approximately 85% of US Physical Therapist Education (PTE) programs. The purpose of this research is to assess if CT skills measured by the GRE match CT skills deemed, by an expert panel, as most important to assess prior to PTE.

Methods: Using a modified E-Delphi approach, a three-phase survey was distributed over 8-weeks to a panel consisting of licensed US physical therapists- experienced in the realm of critical thinking and/or PTE program directors. The CT skills isolated by the expert panel, based on Facione's The Delphi Report were compared to the CT skills assessed by the GRE.

Results: The CT skills supported by The Delphi Report and chosen by the expert panel to assess prior to acceptance into US PTE programs included clarifying meaning, categorization and analyzing arguments. Only clarifying meaning matched the CT skills from the GRE.

Conclusion: The GRE is a test for general admission to graduate programs, lacking context related to healthcare or physical therapy. The current study fails to support the GRE as an assessment tool of CT for applicants for admission to PTE. Development of a context-based admission test where CT skills identified in this study is a key in the admissions process to predict which students will complete US PTE programs and pass licensure exam.
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http://dx.doi.org/10.3352/jeehp.2019.16.24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6760996PMC
April 2020

Management of orbital conjunctival epithelial inclusion cyst using trichloroacetic acid (20%) in an outpatient setting.

Orbit 2020 Apr 20;39(2):147-149. Epub 2019 May 20.

Department of Ophthalmology, Mater Misericordiae Public Hospital, Dublin, Ireland.

Conjunctival epithelial inclusion cysts are an infrequent complication in anophthalmic sockets. The ocular prosthesis may become difficult to retain or it may cause local discomfort. Treatment options described include surgical resection, marsupialisation, and the use of injected sclerosing agents. We present a case of a 27-year-old female who developed a conjunctival epithelial inclusion cyst two years after a left eye evisceration. This invariably caused the ocular prosthesis to become cosmetically unacceptable. Trichloroacetic acid 20% (TCA) was injected intracystically as a minor procedure at the slit lamp. Four months later there was no recurrence of the cyst and the prosthesis retained an excellent position in the socket. This case highlights the successful treatment of a conjunctival epithelial inclusion cyst with TCA (20%) without the need for a surgical procedure.
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http://dx.doi.org/10.1080/01676830.2019.1611882DOI Listing
April 2020

National incidence of eyelid cancer in Ireland (2005-2015).

Eye (Lond) 2019 10 11;33(10):1534-1539. Epub 2019 Apr 11.

Sligo University Hospital, Sligo, Ireland.

Aims: We report on the incidence of cutaneous eyelid tumours in Ireland over the 11-year-period from 2005 to 2015, we identify associations between demographic factors and cutaneous eyelid tumour risk.

Methods: Skin cancers, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), melanoma, and other cancers, located on the eyelid or canthus according to ICD-10 coding, as registered by the National Cancer Registry of Ireland (NCRI), were captured from the period 2005 to 2015. Age standardised rates (ASR) were calculated according to the European Standard Population (2013). Longitudinal data analysis using linear regression, and associations with age and sex were evaluated with the statistics program R.

Results: There were 4824 patients diagnosed with eyelid BCC during the study period, the ASR in men and women was mean 15.87 and 13.49 per 100,00, respectively. The relative risk for eyelid BCC in men compared with women was 1.18, age was associated with incidence. There were 528 patients diagnosed with SCC; the ASR of eyelid SCC in men and women was 2.10 and 1.39 per 100,000, respectively, and increased in women annually (β = 0.07, p = 0.0005). The relative risk for eyelid SCC in men compared with women was 1.51, and age was exponentially associated with SCC. Melanoma and other eyelid tumours were uncommon-50 and 55 cases, respectively.

Conclusion: Incidence of both BCC and SCC increases with age and male sex. The incidence of eyelid SCC is increasing in women, and under age 50, eyelid BCC is more common in women than men.

Synopsis: We describe the recent incidence of eyelid cancers in Ireland, from National Cancer Registry Data. We find eyelid BCC, and also SCC, are associated with increased age. Rate of eyelid SCC is increasing in women.
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http://dx.doi.org/10.1038/s41433-019-0437-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002498PMC
October 2019

Configural learning: a higher form of learning in .

J Exp Biol 2019 02 4;222(Pt 3). Epub 2019 Feb 4.

Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada T2N 4N1

Events typically occur in a specific context and the ability to assign importance to this occurrence plays a significant role in memory formation and recall. When the scent of a crayfish predator (CE) is encountered in strains known to be predator experienced (e.g. the W-strain), enhancement of memory formation and depression of feeding occur, which are part of a suite of anti-predator behaviours. We hypothesized that possess a form of higher-order conditioning, namely configural learning. We tested this by simultaneously exposing W-strain to a carrot food odour (CO) and predator scent (CE). Two hours later, we operantly conditioned these snails with a single 0.5 h training session in CO to determine whether training in CO results in long-term memory (LTM) formation. A series of control experiments followed and demonstrated that only the CO+CE snails trained in CO had acquired enhanced memory-forming ability. Additionally, following CE+CO pairing, CO no longer elicited an increased feeding response. Hence, snails have the ability to undergo configural learning. Following configural learning, CO becomes a risk signal and evokes behavioural responses phenotypically similar to those elicited by exposure to CE.
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http://dx.doi.org/10.1242/jeb.190405DOI Listing
February 2019

A Co-Designed, Culturally-Tailored mHealth Tool to Support Healthy Lifestyles in Māori and Pasifika Communities in New Zealand: Protocol for a Cluster Randomized Controlled Trial.

JMIR Res Protoc 2018 Aug 22;7(8):e10789. Epub 2018 Aug 22.

National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand.

Background: New Zealand urgently requires scalable, effective, behavior change programs to support healthy lifestyles that are tailored to the needs and lived contexts of Māori and Pasifika communities.

Objective: The primary objective of this study is to determine the effects of a co-designed, culturally tailored, lifestyle support mHealth tool (the [email protected]@ mobile phone app and website) on key risk factors and behaviors associated with an increased risk of noncommunicable disease (diet, physical activity, smoking, and alcohol consumption) compared with a control condition.

Methods: A 12-week, community-based, two-arm, cluster-randomized controlled trial will be conducted across New Zealand from January to December 2018. Participants (target N=1280; 64 clusters: 32 Māori, 32 Pasifika; 32 clusters per arm; 20 participants per cluster) will be individuals aged ≥18 years who identify with either Māori or Pasifika ethnicity, live in New Zealand, are interested in improving their health and wellbeing or making lifestyle changes, and have regular access to a mobile phone, tablet, laptop, or computer and to the internet. Clusters will be identified by community coordinators and randomly assigned (1:1 ratio) to either the full [email protected]@ tool or a control version of the app (data collection only plus a weekly notification), stratified by geographic location (Auckland or Waikato) for Pasifika clusters and by region (rural, urban, or provincial) for Māori clusters. All participants will provide self-reported data at baseline and at 4- and 12-weeks postrandomization. The primary outcome is adherence to healthy lifestyle behaviors measured using a self-reported composite health behavior score at 12 weeks that assesses smoking behavior, fruit and vegetable intake, alcohol intake, and physical activity. Secondary outcomes include self-reported body weight, holistic health and wellbeing status, medication use, and recorded engagement with the [email protected]@ tool.

Results: Trial recruitment opened in January 2018 and will close in July 2018. Trial findings are expected to be available early in 2019.

Conclusions: Currently, there are no scalable, evidence-based tools to support Māori or Pasifika individuals who want to improve their eating habits, lose weight, or be more active. This wait-list controlled, cluster-randomized trial will assess the effectiveness of a co-designed, culturally tailored mHealth tool in supporting healthy lifestyles.

Trial Registration: Australia New Zealand Clinical Trials Register ACTRN12617001484336; http://www.ANZCTR.org.au/ACTRN12617001484336.aspx (Archived by WebCite at http://www.webcitation.org/71DX9BsJb).

Registered Report Identifier: RR1-10.2196/10789.
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http://dx.doi.org/10.2196/10789DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125615PMC
August 2018

A randomised controlled trial of the clinical and cost-effectiveness of ultrasound-guided intra-articular corticosteroid and local anaesthetic injections: the hip injection trial (HIT) protocol.

BMC Musculoskelet Disord 2018 Jul 18;19(1):218. Epub 2018 Jul 18.

Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, UK.

Background: Evidence on the effectiveness of intra-articular corticosteroid injection for hip osteoarthritis is limited and conflicting. The primary objective of the Hip Injection Trial (HIT) is to compare pain intensity over 6 months, in people with hip OA between those receiving an ultrasound-guided intra-articular hip injection of corticosteroid with 1% lidocaine hydrochloride plus best current treatment with those receiving best current treatment alone. Secondary objectives are to determine specified comparative clinical and cost-effectiveness outcomes, and to explore, in a linked qualitative study, the lived experiences of patients with hip OA and experiences and impact of, ultrasound-guided intra-articular hip injection.

Methods: The HIT trial is a pragmatic, three-parallel group, single-blind, superiority, randomised controlled trial in patients with painful hip OA with a linked qualitative study. The current protocol is described, in addition to details and rationale for amendments since trial registration. 204 patients with moderate-to-severe hip OA will be recruited. Participants are randomised on an equal basis (1:1:1 ratio) to one of three interventions: (1) best current treatment, (2) best current treatment plus ultrasound-guided intra-articular hip injection of corticosteroid (triamcinolone acetonide 40 mg) with 1% lidocaine hydrochloride, or (3) best current treatment plus an ultrasound-guided intra-articular hip injection of 1% lidocaine hydrochloride alone. The primary endpoint is patient-reported hip pain intensity across 2 weeks, 2 months, 4 months and 6 months post-randomisation. Recruitment is over 29 months with a 6-month follow-up period. To address the primary objective, the analysis will compare participants' 'average' follow-up pain NRS scores, based on a random effects linear repeated-measures model. Data on adverse events are collected and reported in accordance with national guidance and reviewed by external monitoring committees. Individual semi-structured interviews are being conducted with up to 30 trial participants across all three arms of the trial.

Discussion: To ensure healthcare services improve outcomes for patients, we need to ensure there is a robust and appropriate evidence-base to support clinical decision making. The HIT trial will answer important questions regarding the clinical and cost-effectiveness of intra-articular corticosteroid injections.

Trial Registration: ISRCTN: 50550256 , 28th July 2015.
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http://dx.doi.org/10.1186/s12891-018-2153-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052622PMC
July 2018

Mental health of long-term survivors of childhood and young adult cancer: A systematic review.

Int J Cancer 2018 09 15;143(6):1279-1286. Epub 2018 Mar 15.

School of Medicine, University of Leeds, Leeds, United Kingdom.

Childhood cancer is increasing in prevalence whilst survival rates are improving. The prevalence of adult survivors of childhood cancer is consequently increasing. Many survivors suffer long-term consequences of their cancer treatment. Whilst many of these are well documented, relatively little is known about the mental health of survivors of childhood cancer. This article aimed to describe the prevalence and spectrum of mental health problems found in adult survivors of childhood cancer using a systematic review methodology. Our review included 67 articles, describing a number of problems, including depression, anxiety, behavioural problems and drug misuse. Factors increasing the likelihood of mental health problems included treatment with high-dose anthracyclines, cranial irradiation, diagnoses of sarcoma or central nervous system tumours and ongoing physical ill health. There were numerous limitations to the studies we found, including use of siblings of survivors as a control group, self-report methodology and lack of indications for prescriptions when prescribing data were used. This review has identified many mental health problems experienced by survivors of childhood cancer; however, the exact incidence, prevalence and risk-factors for their development remain unclear. Further work to identify childhood cancer patients who are at risk of developing late mental health morbidity is essential.
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http://dx.doi.org/10.1002/ijc.31337DOI Listing
September 2018

Survival from alcoholic hepatitis has not improved over time.

PLoS One 2018 14;13(2):e0192393. Epub 2018 Feb 14.

University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.

Purpose/background: We aimed to describe changes in survival in alcoholic hepatitis (AH) over time by examining published data.

Methods: A systematic literature search of Ovid Embase and PubMed was undertaken using the MESH terms 'hepatitis, alcoholic' to identify randomised controlled trials (RCT) and observational studies (OS) in alcoholic hepatitis. Data were extracted from included studies regarding 28-day, 90-day, 180-day mortality, as well as biochemical and clinical data.

Results: After review of the literature search results, 77 studies published between 1971 and 2016 were analysed, which included data from a total of 8,184 patients. Overall mortality from AH was 26% at 28 days, 29% at 90 days and 44% at 180 days after admission. No changes in mortality over time were observed in univariable analysis at 28 days or 90 days after admission (Pearson correlation r -0.216, p = 0.098, and r 0.121 p = 0.503 respectively). A small but statistically significant increase in mortality was seen in 180-day mortality (r 0.461 p = 0.036). However, after meta-regression to adjust for other factors associated with mortality at each time point, no changes in mortality were seen. Sub-group analysis did not reveal any changes in mortality over time in different study types, or when only biopsy-proven or severe disease were considered.

Conclusion: There has been no improvement in mortality from AH. This is not explained by changes in severity of disease. This emphasises the urgent need for effective treatments for this alcoholic hepatitis.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192393PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812634PMC
April 2018

Propranolol disrupts consolidation of emotional memory in Lymnaea.

Neurobiol Learn Mem 2018 03 3;149:1-9. Epub 2018 Feb 3.

Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 4N1, Canada. Electronic address:

The therapeutic efficacy of the synthetic β-adrenergic receptor blocker, propranolol, for the treatment of post-traumatic stress disorder (PTSD) is currently being debated. Mixed results have been published regarding propranolol's ability to disrupt the consolidation and reconsolidation of memories. Here, we use the invertebrate model Lymnaea to study propranolol's ability to disrupt consolidation of memories formed under varying various types of stress which cause differing degrees of emotional memory. We show that when propranolol is administered immediately following operant conditioning, only the consolidation process of memories enhanced by individual stressors (i.e. a non-emotional memory) is susceptible to disruption. However, when propranolol is administered prior to training, only memories enhanced by a combination of stressors leading to an emotional memory are susceptible to disruption. These data suggest that the time of propranolol administration, as well as the type of memory formed play a key role in propranolol's ability to obstruct memory consolidation.
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http://dx.doi.org/10.1016/j.nlm.2018.01.010DOI Listing
March 2018

July Effect? Maybe not.

Authors:
Emily Hughes

CMAJ 2017 08;189(32):E1050-E1051

CMAJ.

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http://dx.doi.org/10.1503/cmaj.1095466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5555760PMC
August 2017

Epilepsy treatment priorities: answering the questions that matter.

J Neurol Neurosurg Psychiatry 2017 11 1;88(11):999-1001. Epub 2017 Jun 1.

Department of Neurology, University Hospital of Wales, Heath Park, Cardiff, UK.

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http://dx.doi.org/10.1136/jnnp-2016-315135DOI Listing
November 2017

Strain-specific differences of the effects of stress on memory in .

J Exp Biol 2017 03;220(Pt 5):891-899

Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta T2N 4N1, Canada

Stress alters the ability to form, recall and maintain memory according to the Yerkes-Dodson/Hebb (YDH) law. The effects of environmentally relevant stressors, such as low environmental calcium and crowding, on learning and memory have previously been described in a laboratory-reared 'average' strain of (i.e. the Dutch strain) as well as two strains of freshly collected with enhanced memory formation abilities (i.e. 'smart' snails). Here, we use to study the effects of other environmentally relevant stressors on memory formation in two other strains of freshly collected snails, one 'smart' and one 'average'. The stressors we examined are thermal, resource restriction combined with food odour, predator detection and, for the first time, tissue injury (shell damage). We show that the same stressor has significantly different effects on memory formation depending on whether snails are 'smart' or 'average'. Specifically, our data suggest that a stressor or a combination of stressors act to enhance memory in 'average' snails but obstruct memory formation in 'smart' snails. These results are consistent with the YDH law and our hypothesis that 'smart' snails are more easily stressed than 'average' snails.
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http://dx.doi.org/10.1242/jeb.149161DOI Listing
March 2017

Juveniles of Lymnaea 'smart' snails do not perseverate and have the capacity to form LTM.

J Exp Biol 2017 02 17;220(Pt 3):408-413. Epub 2016 Nov 17.

Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, Canada T2N 4N1

Previously, it was concluded that the nervous systems of juvenile snails were not capable of mediating long-term memory (LTM). However, exposure and training of those juvenile snails in the presence of a predator cue significantly altered their ability to learn and form LTM. In addition, there are some strains of Lymnaea which have been identified as 'smart'. These snails form LTM significantly better than the lab-bred strain. Here, we show that juveniles of two smart snail strains not only are capable of associative learning but also have the capacity to form LTM following a single 0.5 h training session. We also show that freshly collected 'wild' 'average' juveniles are also not able to form LTM. Thus, the smart snail phenotype in these strains is expressed in juveniles.
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http://dx.doi.org/10.1242/jeb.147884DOI Listing
February 2017

Qualitatively different memory states in Lymnaea as shown by differential responses to propranolol.

Neurobiol Learn Mem 2016 Dec 23;136:63-73. Epub 2016 Sep 23.

Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada. Electronic address:

Mixed results with the synthetic β-adrenergic receptor blocker, propranolol, have been reported in human populations with regards to its therapeutic efficacy for PTSD treatments targeting the memory reconsolidation process. Stress alters the ability to form and maintain memory, but whether the causal neuronal mechanisms underling memory formation in PTSD are similar to normal memory is not clear. Here, we use Lymnaea to study the effects of combinations of stressors on the quality of the formed memory state. We show reactivation dependent pharmacologic disruption of reconsolidation using propranolol in Lymnaea; specifically, we show that only certain memories created under conditions of a combination of stressors are susceptible to disruption. Our data suggest that phenotypically similar memories may be molecularly diverse, depending on the conditions under which they are formed. Applied to human PTSD, this could account for the mixed results in the literature on disrupting reconsolidation with propranolol.
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http://dx.doi.org/10.1016/j.nlm.2016.09.013DOI Listing
December 2016

Thyroid malignancy presenting with visual loss: an unusual case of paraneoplastic retinopathy.

BMJ Case Rep 2016 Oct 19;2016. Epub 2016 Oct 19.

Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland.

Paraneoplastic retinopathy is a rare cause of painless vision loss, associated with an underlying (and often occult) systemic malignancy. Ocular examination findings are subtle, and the diagnosis is often made on the basis of electrophysiology findings. This report describes the case of a 48-year-old Caucasian man with paraneoplastic retinopathy presenting as visual disturbance, central scotomata and abnormal electrophysiology. He was subsequently diagnosed with papillary thyroid malignancy.
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http://dx.doi.org/10.1136/bcr-2016-216998DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5073693PMC
October 2016

Psychological factors associated with the use of weight management behaviours in young adults.

J Health Psychol 2019 03 25;24(3):337-350. Epub 2016 Oct 25.

3 Queensland University of Technology, Australia.

We modified the Weight Control Behaviours scale to explore unhealthy/healthy behaviours to increase, decrease or maintain weight in young adults ( N = 1082) and associations with body mass index, depression and body image. Females reported more use of all strategies except those which increase body size or exercising to exhaustion. Although the sample reported more use of healthy weight management strategies, the use of dangerous ones warrants attention by healthcare professionals. Feelings of fatness was an important predictor of weight management behaviours. Public health campaigns should focus on the harmfulness of unhealthy weight management practices as well as the importance of healthy ones.
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http://dx.doi.org/10.1177/1359105316675210DOI Listing
March 2019

Angiographic features and disease outcomes of symptomatic retinal arterial macroaneurysms.

Graefes Arch Clin Exp Ophthalmol 2016 Nov 25;254(11):2203-2207. Epub 2016 May 25.

Department of Ophthalmology, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.

Purpose: Symptomatic retinal arterial macroaneurysms (RAM) are primarily investigated by fundus fluorescein angiography after presenting with visual disturbance. The natural history includes spontaneous regression and occasionally occlusion of the arteriole distal to the aneurysm. RAM may be managed conservatively. Interventional treatment options include focal argon laser photocoagulation, Nd:YAG laser hyaloidotomy, and pars plana vitrectomy. The purpose of this study was to elicit the rates of distal vessel occlusion and aneurysm thrombosis in RAM at presentation, and their relevance to the treatment of RAM. Furthermore, visual outcomes were examined.

Methods: Retrospective review of cases of RAM presenting to a tertiary ophthalmology care centre was accomplished in a university teaching hospital. The angiographic features, treatment indications, and visual outcomes in patients with RAM were recorded. Angiographic features noted were distal vessel patency and aneurysm thrombosis at presentation.

Results: Ten patients with RAM were identified. Ninety percent had an angiographically patent distal arteriole, with 40 % showing spontaneous thrombosis of the aneurysm sac at presentation. Patients presenting with a spontaneously thrombosed RAM were managed conservatively, those with flow within the aneurysm wall were treated with focal laser, and those with subhyaloid haemorrhage underwent Nd:YAG laser hyaloidotomy. LogMAR visual acuity improved from 0.3 (±0) at presentation to 0.15 (±0.1) in the conservative group, and from 0.78 (±0.23) to 0.24 (±0.18) in those who underwent one intervention. One patient lost vision after multiple RAM.

Conclusion: Thrombosis within the aneurysm wall is an important feature in deciding to treat RAM, and selective use of interventions improves vision in affected patients.
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http://dx.doi.org/10.1007/s00417-016-3388-9DOI Listing
November 2016

Rasagiline Sensitive Dopamine D2 Receptor Gene Variants: A Step Forward Toward More Personalized Antiparkinsonian Therapy.

Mov Disord Clin Pract 2017 Mar-Apr;4(2):181-182. Epub 2016 Oct 1.

Neurology Plymouth Hospital NHS Trust Devon United Kingdom.

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http://dx.doi.org/10.1002/mdc3.12427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353522PMC
October 2016
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